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British Columbia Premier Christy Clark announced the creation of a study into medicare with a tight, six-month timeline.

It’s a bold agenda,” said Clark. “We need to not just innovate, but also to be sure that we are sharing those innovations all across the country.”

Two premiers — Saskatchewan’s Brad Wall, and Robert Ghiz of P.E.I. — will co-chair the Health Care Innovation Working Group.

“We run 13 distinct health-care operations now across this country and certain provinces are doing certain things better than others,” said Ghiz. “So we think there is a great opportunity for us to be able to collaborate together.”

Moreover, as the Harper government steps back from its traditional role of setting national standards, it is now clear the provinces will move on their own.

“Were going to do our work,” said Wall. “The federal government is not needed for this work. They don’t deliver health care. The expertise is in the provinces and the territories.”

The working group’s other members will include health ministers from all the provinces and territories. Health-care professionals, such as doctors and nurses will be consulted.

The study will focus on three areas:

• Scope of practice

This will revolve around the type of work that health-care providers, such as doctors and nurses, perform. Questions will include whether certain health workers should be given more responsibility to treat patients than they do now and whether there should be more teamwork. The goal is to “better meet patient and population needs in a safe, competent and cost-effective manner.”

“We have a wide range of very highly trained and highly skilled health-care workers,” said Wall. “Are we maximizing their scope of practice to better deliver on innovation? To keep facilities open in rural and remote areas perhaps in unconventional ways? Are we utilizing nurse practitioners the way we should? Are we utilizing pharmacists the way we should? These are the issues we will explore.”

• Human resources management

The cost of paying salaries to health workers, such as doctors and nurses, is a huge part of provincial medicare bills. Provinces complain that they often find themselves in competition with each other over salaries, as one jurisdiction hikes wages, the province next door is forced to follow suit. The review will attempt to “explore more co-ordinated management to address competition across health systems.”

“I think it is important in this country that we stop, as much as we can, competing with each other for professionals in the health-care system,” said Clark. “Labour costs are a huge part of all of our budgets. So, as long as we are competing with each other, it’s only going to get more expensive.”

• Clinical practice guidelines

The ways patients are treated, known as clinical practice guidelines, vary across the country. Provinces suspect there are cases where some treatments are unnecessary or don’t work, and are sometimes too costly. They would like to share with each other their “best clinical and surgical practice guidelines so that all Canadians benefit from up-to-date practices.”

Wall said his working group will consult with medical professionals for their advice and he suspects it won’t be long before they identify up to 10 “high-volume procedures” that aren’t providing optimal care.

The results of the study will be reported to provincial and territorial leaders when they meet in Halifax in July.

Representative of associations representing the country’s doctors and nurses said they were pleased that health-care workers would be consulted.

“I think it’s an opportunity to put the patient at the centre of the system that has left them behind,” said Dr. John Haggie, president of the Canadian Medical Association. “I think it signals a change in the sense that the premiers have taken some ownership of this and that’s very encouraging.”

Rachel Bard, CEO of the Canadian Nurses Association, concurred, saying it’s a good first step.

“What we see here is an opportunity to transform the system,” she said.

The provinces had hoped to convince Prime Minister Stephen Harper to bolster a long-term plan for federal health-care funding with an additional “innovation fund” to finance special projects.

But Harper shot down that idea this week, telling a TV interviewer the federal government won’t provide any more funds to the provinces for health care than those unveiled by Finance Minister Jim Flaherty last month.

Clark and other premiers said Tuesday they will proceed with their own study but haven’t given up on persuading Harper to change his mind.

Ghiz suggested the federal Tories might decide to provide the funds in 2014-15 — just as they are approaching the next election.

Wall said he thinks Tory MPs will hear from Canadians on the issue, particularly as they see provinces working together to innovate.

“We think that hopefully, there will be increasing pressure for them to be part of this,” said Wall. “It’s the No. 1 issue in the country and I can’t see why they wouldn’t want to be interested in it.”

Clark suggested that the issue should not be seen as a provincial-federal spat over funding.

“It’s about Canadians needing their federal government to be engaged in health care. Its about senior citizens needing their federal government to be there for them in the health-care system.”

The premiers came to this week’s summit pledging to work together to reform the health-care system through innovations.

Their goal is to find ways to spend billions of health-care dollars more efficiently while improving patient care, and ultimately, to ensure medicare’s future sustainability.

Their health-care costs have steadily been ballooning in recent years.

For four years in the mid 1990s, provincial and territorial health spending slowed to a virtual halt. Then the taps were opened.

In 1995, provinces and territories spent $49-billion on health care. In 2011, the tab is expected to have reached $130.3-billion.